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CVA Tx Techniques

COTA Exam

dysphagia upright position when feeding, understand prescribed foods and liquids, observe client closely while eating, educate, demonstrate competence for emergency procedures for choking and aspiration
balance impairment supportive devices: lateral trunk supports, seat belts, lapboards
ROM prom, self-rom, aarom, arom prom should be performed at least twice daily and continued indefinitely if sufficient active movement does not return
subluxation/shoulder pain can be prevented through proper positioning, prom exercises, and education on handling techniques. the affected UE should be supported at all times when upright during functional ambulation, the client may benefit from kinesotaping the arm at the shoulder. the use of arm slings is controversial because they tend to increase the flexed adducted posture while reducing sensory feedback, w/o reducing risk of subluxation. clients with severe edema may require a sling temporarily during transfers or gait training
ifluencing muscle tone active movement of hypotonic muscles can be facilitated through stimulation of various sensations in the presence of increased tone, slow and controlled movements should be encouraged. clients should be discouraged from excessive effort. tactile and proprioceptive input can decrease high tone specialized training in this area is required
bilateral integration the affected UE should be properly positioned and kept within the client's view during one-handed activities as motor function returns, the affected arm initially serves as a stabilier and progresses to being a gross assist, then partial assist, and may eventually become functional in all tasks
strengthening and endurance strengthening of the unaffected side is appropriate if increased resistance does not increase spasticity of the hemiplegic side
elevation and retrograde massage the presence of severe edema may be an early sign of reflex sympathetic dystrophy (rsd), also known as complex regional pain syndrome, and should be addressed immediately edema can be prevented by: elevation, AROM, elastic stockings, compression devices, and retrograde manual massage of the elevated hand (beginning at the fingertips and moving toward the elbow) can be performed by client, family, or clinician
motor retraining select and engage client in activities that are goal-directed, task-oriented, and meaningful. match activities with client's skill level and grade activity up as client improves provide opportunities for client to perform activities in different positions (sitting, standing). teach client to think about movement while performing activity. allow client opportunities to practice
impaired attention brief, frequent sessions in activities of high interest in a nondistracting environment time and difficulty are increased as the client's capacity increases. these activities can be provided in a group format or individually orientation methods include reality orientation, reminiscence therapy, use of family pictures, labeling client's belongings, using calendars and watches, or using props for holidays
positioning techniques alternate between supine and side-lying at 2-4 hour intervals. symmetry of trunk alignment is desirable the affected arm should be supported in supine and side-lying on the unaffected side to reduce edema and prevent injury. the affected leg should be positioned to encourage hip and knee flexion in upright sitting, the trunk should be symmetrical and erect. the affected arm should be supported with pillows, bedside table, or lap tray. feet should be supported at all times
resting hand splint most commonly used to protect affected forearm, wrist, and hand and to prevent contractures and deformities the splint must be removed periodically during the day to prevent learned nonuse, to promote sensory awareness of the hand, and to encourage functional use maintains and supports hand in clients with hypotonia. maintains tissue length and provides a gentle stretch for clients with spasticity
Created by: Sarah Hamrick Sarah Hamrick on 2012-06-06



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